Culture

Andrew Denton Wants Australia To Have A Long, Hard Conversation About Voluntary Assisted Death

Should voluntary assisted death be legal, and extend to those with severe mental health issues? Denton thinks so. We spoke to him about it.

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Content note: this interview discusses terminal illness, mental illness, and suicide.

The night before I interview Andrew Denton, I’m sitting in the majestic surrounds of the Plaza Ballroom with a table full of strangers for the second annual Di Gribble Argument. Formally attired waitstaff discreetly drop by to top up our glasses with Champagne – the real-deal French stuff, provided by one of the evening’s sponsors – and whisk away our dinner plates. Denton himself is on stage, delivering an impassioned, but also meticulously researched, argument for the legalisation of voluntary assisted death (a full transcript of which can be found here).

Throughout the course of his speech, the just-past-middle-aged woman seated to my left weeps silently, occasionally wiping away the tears that trickle down her face. Later, over petit-fours and coffee, she tells me that she was crying because the discussion brought back painful memories of the manner in which her own father passed away. In return, I tell her about my friend who has stage IV cancer and faces the possibility of a slow and painful death from liver failure.

Everyone, it seems, has a personal connection to the topic.

Initially, there appears to be something of a disconnect between the subject matter of the evening and the high-bourgeois trappings of its staging. But death doesn’t discriminate – every single one of us will eventually die, and how we die might well be a matter in which we have very little choice. It’s an issue that came to the fore this week, after Robin Williams’ widow Susan Williams spoke publicly about his death for the first time, explaining it was “the endless parade of symptoms” of Lewy body dementia that drove her husband to suicide — not depression, as was widely assumed.

Denton’s aim in delivering the second Di Gribble Argument – as well as in producing a forthcoming podcast, Better Off Dead, that will go into further depth on this subject; and in appearing in next week’s Q and A, which is themed around ‘Facing Death’ – is to provide Australians with choices about the end of their lives, so that those whose final days might otherwise be extremely painful or undignified can die peacefully at a time of their own choosing.

Before that can happen, though, there needs to be legislative change to protect doctors and patients. I sat down with Denton to discuss it.

Junkee: Voluntary assisted death isn’t exactly a pleasant topic. How did you start to think about it, and what drew you towards campaigning for it?

Andrew Denton: It’s little wonder we Australians don’t look at this topic, because who wants to think about dying? But, spoiler alert: it’s gonna happen. My dad died eighteen years ago, and – sadly, I don’t think this is an uncommon story in this country – he died badly. He had three days of pain, which the pain relief didn’t help. And I thought then, as I think now, couldn’t we have done better than that?

Then a couple of years ago, I read an article by an Australian writer whose dad was Dutch and had cancer, and under Netherlands law he could be given euthanasia. I read about his death last week, where he farewelled his friends, about his last night with his family, where he listened to his favourite music then died peacefully, on his own terms. I just thought: why can’t we do that here? What’s stopping that? How can the Netherlands work it out in a way that clearly works, but we’re told here it’s too hard, it can’t be done?

Your speech last night gave short shrift to the arguments against voluntary assisted death. Have you always felt that way? Or did your convictions grow firmer the more you researched the topic? 

My knowledge became firmer. I started from a neutral position: I wanted to see voluntary assisted death laws introduced here, but I wanted to know why they couldn’t be. The first port of call was a big anti-euthanasia convention, and I took their claims very seriously. I took very careful notes; I filled a notebook with facts and figures and I interviewed [the attendees]. I would say, in the end I didn’t give short shrift – I gave very long shrift. Because, really, their criticism and their claims informed everything I did. Everywhere I went, I thought, ‘This is what they’re saying – I’m going to ask these people if this is what’s happening. I’m going to explore this for myself.’ And believe me, I have looked at their figures and their claims inside out, upside down, in every way that I possibly could.

So while I started from a position of thinking that these laws should happen, by the end of this process I feel just as strongly about that, but I’ve also come to realise that the arguments put forward to suggest that these laws are not safe, or that certain people are being victimised by them – they’re not true. They’re just not true.

A number of polls suggest that the majority of Australians support the legalisation of voluntary assisted death. So what, in your opinion, is preventing change on this issue?

I wish I had a simple answer to that, because then we could raid that person’s house and force them to change their mind! Look, there are people who oppose this on perfectly legitimate moral and ethical grounds: it offends their morality. And I have no issue with that; people are allowed to hold different moral views of the universe. Clearly the core of that is the Catholic church, and they still hold a position of some power and influence in the Australian political discussion.

But I’ve also realised … that these laws have happened overseas – in Belgium, the Netherlands, Oregon – because doctors were honest with themselves about what they were doing. And what they were doing there, as they are doing here, was assisting people to die. So they came to the realisation that it’s probably better to have a law – to protect them and to protect their patients – than just doing it in a way where nobody knows what’s actually going on.

I think medical professionals here, for reasons I’m not quite sure of, have been slow to have that conversation amongst themselves. And until and unless they do, and are honest about what’s happening, I don’t think there will be change in this country – because no politician will campaign for significant new health law if they think the medical profession is against it.

What do you think is the cause of this reticence from Australian doctors? 

I don’t really know. I think that doctors by nature are conservative people – and that’s not a bad thing. For whatever reason, the sense that I got from talking to people in the medical community is that they don’t know much about what’s going on overseas, and not a lot of effort has gone into educating them about it. My sense is that the leadership of organisations such as the Australian Medical Association and Palliative Care Australia don’t want to participate in this conversation, and in some cases actively want to block it.

Now it’s one thing for them to hold a moral or ethical view; it’s another thing for them to block off a conversation that affects their patients, and which I would also argue affects their doctors. One thing I’m hoping to do with this podcast and these talks is to prompt the Australian medical community into looking again, learning more, and speaking up.

I presume you wouldn’t embark upon this project of starting a national conversation about voluntary assisted death if you didn’t think it was in some sense a tractable problem. But, realistically, what are the chances of us making legislative progress on this issue?

It’s a difficult issue politically, because it’s not sexy like gay marriage – it’s a subject a lot of people don’t want to look at. On the other hand, no other issue has greater long-term public support than this.

Unfortunately, death is something that affects all of us, and I meet very few people who don’t have a story that relates to this issue. And change is all around us: Canada has just legalised assisted dying. California has just done it. There are five states in the United States – a more conservative, religious country than Australia – that have this law. New Zealand is now having open parliamentary debate about it.

Things are changing around us, and the more that these laws come into existence, the more that they also demonstrate that they can be done, that they’re safe, that they work the way they’re supposed to. The opposing arguments then become slimmer and slimmer. The hardest part is to get the conversation started in an honest way, and that’s what I’m trying to do.

The same-sex marriage parallel is interesting, because one of the things supporters of same-sex marriage frequently say is that if you’re opposed to same-sex marriage, don’t have one. It seems that voluntary assisted dying is quite similar in that regard – if you are morally opposed to it, fine, don’t avail yourself of the option, but your opposition to it shouldn’t deny others the right to it.

I think there’s truth in that. The only significant difference – and it is significant – is that while only a certain percentage of the population will be involved in gay marriage, everyone’s going to die. So while these laws would only apply to a small percentage of the population, none of us knows if we’re going to be part of that population. And that’s why it’s an issue that’s of vital importance to all of us – it could be you in that position who needs help, or it could be someone you love.

This also isn’t an issue that’s restricted to elderly people – young people can die terrible, prolonged deaths from diseases like cancer, too.

It can even happen to children. Belgium has been attacked for extending their euthanasia laws to children, but as somebody I spoke to in Belgium said, so what? Minors don’t get terrible illnesses? Minors don’t suffer? So yes, it can happen to anybody.

Similarly, a bad death, or a self-inflicted violent death because someone feels that they have no other option, leaves scars for everyone left behind. I think those scars are all over this country.

One of the more controversial elements of your argument is that it would extend the right to voluntary assisted death to those with severe mental health issues.

It’s a very, very complex issue, and it’s on the fringes of this question. I preface this by saying that in all these places with these laws, the vast majority of people seeking assisted death have the diseases you would expect: cancer, heart failure, neurological disorders.

In Belgium they are proceeding with the issue of voluntary assisted death for mental health issues very cautiously and very slowly. It is hard. But one thing that all the people I have spoken to are clear about is that there can be psychiatric illnesses which are long-term and are resistant to any kind of therapy. The last thing that these doctors want is for these people to die, but if they think the patient is in a position where their suffering is indeed unendurable and untreatable, they will grant them the legal right to consider voluntary assisted death as an option, but they will continue to work with that patient to see if there’s a way to help them.

Interestingly, the general sense is that, in this area of psychiatric illnesses, they have helped more people [to live] than they have helped to die. I see that as a very rational and compassionate thing to do.

Guy Rundle from Crikey tried to get you to expand on what he saw as a contradiction in your support of voluntary assisted death for those with severe mental illnesses, because your own proposal for legislative change stresses that the person who receives assistance would have to be legally competent, or capable of giving informed consent. A person suffering from a mental illness might not be in a position to give that informed consent. 

I asked that same question of a number of people, and they said it was a mistake to assume that anybody with mental illness is not mentally competent. So, for example, bulimia is a mental illness, but if you suffer from it, it doesn’t mean that you’re not competent to understand what is going on and make decisions about your life.

Clearly if you’re psychotic, delusional, or schizophrenic and hearing voices, then you’re not mentally competent. But there are a lot of other people who, whatever their mental illness is, it doesn’t mean they’re not capable of fully addressing, discussing, and engaging with the question of what is happening with their life. I have no reason not to trust the people whose life’s work it is to deal with people with psychiatric illnesses when they say this.

In your Di Gribble Argument you quoted a great line from the Canadian Justice Lyn Smith, who says, “It is unethical to refuse to relieve the suffering of a patient who requests and requires such relief, simply in order to protect other hypothetical patients from hypothetical harm.”  

And they have worked! These hypotheticals have worked. The number one slur that’s thrown out is that the elderly and the disabled are – and this is the language used – are being made expendable, are being made disposable. This is where I my enquiries started, and I was quite shocked by this. I can now say, hand on heart, quite comprehensively, that what I discovered was there’s zero evidence of this. So I came away with the view that those running these arguments are deeply cynical, and I think they’ve actually created fear – I know they’ve created fear – in the very communities they claim to be protecting.

Andrew Denton’s podcast about voluntary assisted death, Better Off Dead, will be ready by January 2016 and released with the support of The Wheeler Centre. You can subscribe to their newsletter for updates.

 

Andrew Denton will appear on a special episode of Q And A on Monday night, along with Karen Hitchcock (the author of a Quarterly Essay on caring for the elderly); palliative care specialist Ralph McConaghy, vice president of Dying with Dignity Victoria, Rodney Syme; and retired homeopath and psychotherapist for cancer patients, Ana Lamaro.

 

Chad Parkhill is a Melbourne-based writer and editor. He has written for The AustralianThe Lifted BrowKillings (the blog of Kill Your Darlings), Meanjin and The Quietus, and tweets from @ChadParkhill